Context factors in general practitioner - patient encounters and their impact on assessing communication skills - an exploratory study

Abstract

BackgroundAssessment of medical communication performance usually focuses on rating generically applicable, well-defined communication skills. However, in daily practice, communication is determined by (specific) context factors, such as acquaintance with the patient, or the presented problem. Merely valuing the presence of generic skills may not do justice to the doctor’s proficiency.Our aim was to perform an exploratory study on how assessment of general practitioner (GP) communication performance changes if context factors are explicitly taken into account.MethodsWe used a mixed method design to explore how ratings would change. A random sample of 40 everyday GP consultations was used to see if previously identified context factors could be observed again. The sample was rated twice using a widely used assessment instrument (the MAAS-Global), first in the standard way and secondly after context factors were explicitly taken into account, by using a context-specific rating protocol to assess communication performance in the workplace. In between first and second rating, the presence of context factors was established. Item score differences were calculated using paired sample t-tests.ResultsIn 38 out of 40 consultations, context factors prompted application of the context-specific rating protocol. Mean overall score on the 7-point MAAS-Global scale increased from 2.98 in standard to 3.66 in the context-specific rating (p < 0.00); the effect size for the total mean score was 0.84. In earlier research the minimum standard score for adequate communication was set at 3.17.ConclusionsApplying the protocol, the mean overall score rose above the level set in an earlier study for the MAAS-Global scores to represent ‘adequate GP communication behaviour’. Our findings indicate that incorporating context factors in communication assessment thus makes a meaningful difference and shows that context factors should be considered as ‘signal’ instead of ‘noise’ in GP communication assessment. Explicating context factors leads to a more deliberate and transparent rating of GP communication performance.

‘No need to worry’: an exploration of general practitioners’ reassuring strategies

“…Thus, GPs seemed to tailor their reassurance to the context of that specific consultation, which explains why they described such a wide variety of strategies. The context-specific and goal-directed character of doctor-patient communication has also been shown in previous research [27,40,41]. The situation-specificity of reassurance has also been demonstrated in our study exploring the patients’ perspective on reassurance, which showed that what is experienced as reassuring by patients largely depends on their specific worrying cognitions [38].…”

‘I still have no idea why this patient was here’: An exploration of the difficulties GP trainees experience when gathering information

“…Trainees' reflections on situations during which the skills they have learned during medical training are ineffective, again underline that the context-specific nature of medical communication in daily practice should not be ignored [27][28][29][30]. In line with previous studies, there seems to be a need for more tailored, context-specific communication strategies that are adaptable to specific situations [31,32].…”

Reliability and validity of OSCE checklists used to assess the communication skills of undergraduate medical students: A systematic review

“…This instrument is being used, in real-time and in recorded sessions, to assess students, physicians and/or nurses at only a small number of institutions in different countries. However, it is important to recognize that it is not being more widely adopted as a gold standard [73][74][75]. It is apparent from this review that the majority of CS assessment is based upon the individual development of unique measurement instruments which are used only at local level.…”